Rx Update: June 2000
Transition From Intravenous To Oral Therapy
Mary Ross, R.Ph., M.B.A.
Peer Review Status: Internally Reviewed
Converting patients from intravenous to oral therapy as soon as possible is advantageous and more convenient to the patient and nursing staff, as well as being more cost effective. Nurses, pharmacists and physicians can collaborate to identify potential candidates for conversion from intravenous to oral therapy, thereby providing patients with cost-effective alternatives when appropriate.
Medications which have been targeted and reviewed by the Pharmacy and Therapeutics (P&T) Subcommittee for transition from intravenous to oral therapy include: ketorolac, fluconazole, H2 receptor antagonists (e.g., cimetidine and famotidine), acyclovir and antibiotics (e.g., ampicillin/sulbactam, azithromycin, cefazolin, ceftriaxone, erythromycin, levofloxacin, piperacillin/tazobactam, ticarcillin/clavulanate, and trimethoprim/sulfamethoxazole).
Rationale For Transition From IV To PO
- Added convenience of the patient-increased mobility and comfort.
- Prevention of complications from IV therapy such as phlebitis (reported to affect as many as 30-70%
of all infusions),1,2 septicemia due to line infection, tissue damage from extravasation, etc.
- Oral medications are less expensive than intravenous medications and have fewer hidden costs.
- Oral medications require less nursing and pharmacy preparation and administration time.
- Converting to an oral medication earlier in therapy may decrease the patient's length of stay
Candidates For Conversion
- Patient has a condition treatable by an oral form of the medication.
- Patient has a functioning GI tract for adequate absorption (use caution in cases of diarrhea or vomiting.)
- Patient is currently receiving a soft or regular diet and/or is taking other oral medications.
- The patient's condition is improving as indicated from clinical findings (e.g., temperature and white blood cell count are returning toward normal in a patient being treated for an infection).
Conversion Not Recommended
- Patient is critically ill or patient's condition is deteriorating.
- Patient is on a protocol or study which specifies the IV form of the medication.
- Patient is NPO.
- Patient has uncontrolled nausea or vomiting.
- Administration of oral medications by established feeding tube is not possible or advisable.
1Formulary 1997; 32: 944-59
2Pharmacotherapy 1997; 2: 271-6
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